Revenue integrity strives to prevent risk reoccurrence and lessen its impact. As any doctor will tell you, it’s better to prevent illness than to treat it. To prevent problems, in this instance, you need to use technology to your advantage. You need to make process improvements such as teaching staff to use the technology you have more adeptly, creating and follow best practice rules and ensuring correct payment through proper pricing, charging, coding and documentation.
I’m not advocating an unnecessary spend—in reality automating your chargemaster is as vital to the health of your hospital as having great physicians and top-notch medical equipment. Just ask Doug Barry, vice president of revenue cycle and HIM for Glen Falls Hospital in Glen Falls, NY.
This 400-bed hospital, largest one situated between Albany, NY and Montreal, Canada, includes a main acute care hospital campus and 28 health care facilities and a service area that stretches across six, primarily rural, counties and 3,300 square miles. The breadth of their coverage area means that many of the services they provide do not generate enough revenue to pay for themselves—a situation to which many other facilities can relate. For Glen Falls Hospital, optimizing their revenue is critical, which is why in fall 2009 the facility decided to invest a six-figure sum into automated revenue integrity software.
When the market tanked, Glen Falls Hospital went through the same budgetary overhaul that many hospitals nationwide did, however, at the end of their process they had cut their highly skilled chargemaster person. Recognizing this error, they promoted from within but still needed to train this person and provide the tools to discern where their revenue was leaking. It was time to automate. After researching and talking with various vendors, they landed on Craneware, based in Atlanta, GA.
“We needed this software for continuity and consistency. For us it was the absence of the intellectual capital [that made us realize] we needed to automate this process,” says Barry. “It’s an area with a high volume of activity; you need to have a control point.”
Prior to taking the software live, Barry’s team trained on it. What they found? Along with improvements in their ability to efficiently price, charge and code for services, their reporting and data mining processes went from being a weeklong effort to three to four minutes.